Obstruction Of Gastrointestinal Tract Research Articles

Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future

Colorectal diseases are increasing due to altered lifestyle, genetic, and environmental factors. Colonoscopy plays an important role in diagnosis. Advances in colonoscope (ultrathin scope, magnetic scope, capsule) and technological gadgets (Balloon assisted scope, third eye retroscope, NaviAid G-EYE, dye-based chromoendoscopy, virtual chromoendoscopy, narrow band imaging, i-SCAN, etc. ) have made colonoscopy more comfortable and efficient. Now in-vivo microscopy can be performed using confocal laser endomicroscopy, optical coherence tomography, spectroscopy, etc. Besides developments in diagnostic colonoscopy, therapeutic colonoscopy has improved to manage lower gastrointestinal tract bleeding, obstruction, perforations, resection polyps, and early colorectal cancers. The introduction of combined endo-laparoscopic surgery and robotic endoscopic surgery has made these interventions feasible. The role of artificial intelligence in the diagnosis and management of colorectal diseases is also increasing day by day. Hence, this article is to review cutting-edge developments in endoscopic principles for the management of colorectal diseases.

Role of opioid use in gastrointestinal obstruction and perforation: A retrospective review.

Pain is one of the most common complaints that brings a patient to a hospital. For this, usually, the patient might have already consumed various types of pain killer combinations, either prescribed or over-the-counter. In some of these cases, a patient consumes these medicines unmonitored for a long time and then comes with complications, among which gastrointestinal tract obstruction and perforation are the most life threatening. Case files from the Department of Surgery were retrieved and studied. Patients were contacted telephonically for details of drug abuse history. These were then further studied in detail. Forty-eight (68 percent) patients out of a total of 78 had a history of drug abuse. The most commonly abused pain killer was a combination of anti-inflammatory and other salts, which was found in 22 (46 percent) patients, followed by tramadol, NSAIDs, opium, and alcohol (23, 17, 10, and 4 percent, respectively). These groups were comparable in socio-demographic details except in the mean age, occupation, and gender distribution, and the difference was significant (p < 0.01). The most common cause for starting to use any of the above-mentioned pain killer was persistent pain. The most common site of obstruction in drug abusers was the stomach (60 percent), followed by the small intestine (38 percent) and the large intestine (2 percent). (1) This is an observational retrospective record review. (2) Records were studied in hospital settings, so results should be generalized cautiously. (3) Risk of recall bias is present. Pain killers should always be prescribed with caution and for a short duration. Alternative options for pain relief should be made available, and doctors should be trained. Drug abusers tend to have a gastrointestinal complication at an early age, which means they are prone to further complications and recurrence if the problem is not addressed on time.

A prospective observational study on etiology and management influencing outcome in operatively managed cases of acute intestinal obstruction in adults

Background: Acute intestinal obstruction (IO) is an important cause for acute abdomen in surgery which presents as abdominal pain, vomiting, distension, and constipation depending on the level and extent of obstruction of gastrointestinal tract. Early diagnosis of acute IO with understanding of various etiologies, use of better diagnostic techniques, and skillful operative management and good postoperative care, carries a good outcome. Aims and Objectives: The objective of the study was to find out the prevalence of various etiologies of acute IO and to study the various post-operative morbidity and mortality. Materials and Methods: This was a hospital-based observational study in the Department of General Surgery of Calcutta National Medical College and Hospital among patients with a diagnosis of acute IO during the study period of December 2016-April 2018. Results: Acute IO commonly affects male with a male: female ratio 7:3 and the most common occurrence in the age group of 40–59 years (30%). The most common etiology was obstructed/strangulated hernia (36%), followed by large bowel neoplasm (18%), adhesion (16%), intestinal tuberculosis (12%), and volvulus (10%). The most common surgical procedure performed was the resection of gangrenous bowel and creation of stoma (30%), followed by prosthetic repair of hernia (28%). The mortality rate of the present study was 12%. The morbidity rate was 46%attributing mainly to respiratory complications (30.4%) and surgical site infections (26.08%). Conclusion: This study demonstrates that the pattern of IO differs from the Western world with obstructed hernias being the most important cause and also emphasizes the fact that intestinal tuberculosis assumes a prominent role.

A Systematic Approach to Patients with Elevated Levels of Serum Amylase or Lipase

Serum amylase and lipase tests are routinely performed in patients presenting with abdominal pain or even during regular health screening. Elevated serum levels of these two enzymes are often encountered in clinical practice. The differential diagnosis is broad and includes acute pancreatitis, chronic pancreatitis, gastrointestinal tract obstruction, malignancies, and other disease conditions. In this article, we review the pathophysiology of elevated amylase and lipase, possible conditions that cause the increase, and diagnostic strategies for such patients. We conclude that a systematic approach to patients with elevated amylase and/or lipase is critical to making an accurate diagnosis and initiating appropriate treatment.

CIRSE Standards of Practice on Oesophageal and Gastroduodenal Stenting

BackgroundImage-guided insertion of stents in the upper gastrointestinal trunk is an effective, minimally invasive treatment option to provide immediate relief of symptoms caused by upper gastrointestinal tract obstruction related to advanced-stage malignant causes or benign causes that lead to lumen narrowing.PurposeThis document, as with all CIRSE Standards of Practice documents, is not intended to impose a standard of clinical patient care but will recommend a reasonable approach to best practices for performing stenting of the upper gastrointestinal tract, namely the oesophageal and gastroduodenal segments. Our purpose is to provide up-to-date recommendations for placement of upper gastrointestinal tract stents based on the previously published guidelines on this topic in 2005 and 2007.MethodsThe writing group was established by the CIRSE Standards of Practice Committee and consisted of a group of internationally recognised experts in performing upper gastrointestinal stenting. The writing group reviewed the existing literature using PubMed to search for relevant publications in the English language up to September 2021. The final recommendations were formulated through consensus.ConclusionInsertion of stents in the oesophageal and gastroduodenal tracts has an established role in the successful management of malignant or benign obstructions. This Standards of Practice document provides up-to-date recommendations for the safe performance of upper gastrointestinal stent placement.

Home-visit nutrition and diet guidance for gastrointestinal tract obstruction in cancer patients

Home-visit nutrition and diet guidance for gastrointestinal tract obstruction in cancer patients

Superior Mesenteric Artery Syndrome.

We report a unique case of obstruction of the upper gastrointestinal tract diagnosed in a 15-year boy presenting with a 6-month history of persistent abdominal pain, epigastric fullness, repeated episodes of vomiting, and significant weight loss. The computed tomography (CT) scan of the abdomen with intravenous and oral contrast demonstrated the angle between the aorta and superior mesenteric artery (SMA) to be 15° and revealed the stomach and duodenum to be massively dilated, leading up to a diagnosis of SMA syndrome, which was successfully operated. SMA syndrome is a challenging diagnosis and must always be included in the list of probable diagnoses causing obstruction of the upper gastrointestinal tract. Key Words: Upper gastrointestinal obstruction, Superior mesenteric artery syndrome, Small bowel obstruction, Duodenojejunostomy.

Ovarian torsion causing bowel obstruction in a premature infant

We report a case of 3-months-old infant with diagnosed complex ovarian cyst admitted to the hospital with acute onset of clinical signs of upper gastrointestinal tract obstruction. Urgent laparotomy was performed. A Treves' field mesenterial defect with herniation of small bowel loops and a complex ovarian cyst with torsion was identified. Unexpectedly, the Fallopian tube as a strangulation band of the herniated bowel loops was discovered within the mesenterial defect. During the operation bowel loops reduction, mesenterial defect closure and left adnexectomy due to presence of necrotic changes was done. Perioperatively, coincidental malrotation with Ladd's bands were found, thus Ladd's procedure was performed. Finally, right small paraovarian simplex cyst was fenestrated. The following postoperative course was uneventful. To the best of our knowledge, it is the first case report described in literature proposing unusual combination of congenital anomalies leading to acute intestinal obstruction.

An Impressive Case of Compulsive Chicken Bones Ingestion.

CASE REPORT A 53-year-old woman with a medical history of depression and anxiety was admitted because of idiopathic anaphylaxis. Owing to acute respiratory failure, she underwent a thoracic computed tomography scan, which revealed a large number of bone fragments inside the stomach and duodenum (Figure 1). The patient was evaluated by psychiatry and admitted because she had ingested numerous chicken legs in the context of acute alcohol intoxication. We had some concerns about the efficacy and safety of performing an upper gastrointestinal endoscopy in this scenario. Indeed, there were already some bone fragments beyond the proximal duodenum and the objects were numerous and sharp. Thus, there was a high risk of complications (e.g., perforation and aspiration) during the procedure, with the probability of successful removal of all the fragments being very low. Therefore, we chose to start treatment with metoclopramide. During hospitalization, she underwent daily abdominal imaging examinations, which showed progression of the bone fragments through the small bowel and colon (Figure 2), with no evidence of obstruction or perforation. Later, the patient started oral feeding, with good tolerance. Because she maintained abdominal pain, and to exclude local complications, a colonoscopy was performed 10 days after admission. No foreign bodies or mucosal changes were identified. Given the progressive improvement in her clinical condition, the patient was discharged and oriented to immunoallergy and psychiatry consultation.Figure 1.: Computed tomography scan showing multiple chicken legs inside (A) the stomach and (B) the duodenum, with no evidence of obstruction or perforation.Figure 2.: Computed tomography scan showing the progression of the bone fragments through the small bowel and colon, without complications.We report an impressive case of ingestion of large amounts of chicken bones, which crossed the entire gastrointestinal tract without complications and only minor symptoms. Foreign body ingestion remains a common problem both in pediatric and adult populations.1,2 The associated morbidity and mortality are significant, with some reports estimating that nearly 1,500 deaths occur annually in the United States due to foreign body ingestion.3 In fact, sharp foreign bodies such as chicken bones can lead to acute and life-threatening complications, such as obstruction, hemorrhage, perforation, and associated infection, including peritonitis and sepsis.4 Complications and their severity are usually related to the object ingested, its location, and the amount of time that has passed since the ingestion.5 Gastrointestinal tract obstruction and perforations have been reported in all segments but tend to occur at sites of acute angulation. DISCLOSURES Authors contributions: I. Garrido drafted the manuscript and is the guarantor of the article. I. Garrido, P. Moutinho-Ribeiro, and G. Macedo critically revised and finalized the manuscript. All authors approved the final version of the manuscript. Financial disclosure: None to report. Informed consent was obtained for this case report.

Chromosomal Abnormalities and Pregnancy Outcomes for Fetuses With Gastrointestinal Tract Obstructions

Fetal gastrointestinal tract obstruction (GITO) is the most frequently encountered gastrointestinal defect in the prenatal period. This study aimed to investigate the genetic disorders and pregnancy outcomes of fetal GITO. We reviewed data from 70 pregnancies that were referred for invasive prenatal testing because of fetal GITO. According to the level of obstruction, they were classified into esophageal atresia/stenosis, duodenal atresia/stenosis, jejunal or ileal atresia/stenosis, or anal atresia. Traditional karyotyping was performed on all the 70 pregnancies, and chromosomal microarray analysis (CMA) was performed on 32 of them in parallel. Traditional karyotyping revealed twelve (17.1%) chromosomal abnormalities, including 11 cases of trisomy 21 (Down syndrome), and one case of a supernumerary marker chromosome related to Cat eye syndrome. According to the absence or presence of other ultrasound anomalies, they were categorized into isolated GITO (n = 36) and non-isolated GITO (n = 34). The rate of chromosomal abnormalities in the non-isolated GITO pregnancies was significantly higher than that in the isolated GITO pregnancies (29.4 vs. 5.5%, p < 0.05); the survival rate in the isolated group was significantly higher than that in the non-isolated group (67.6 vs. 34.4%, p < 0.05). Among the 32 cases where CMA was performed, an additional one (3.1%) copy number variant with clinical significance was noted in a fetus with normal karyotype. The microduplication on 7q12 was considered to be the genetic etiology of duodenal stenosis, although it was inherited from a phenotypically normal mother. Our study supports the strong association between Down syndrome and fetal GITO, especially duodenal stenosis. Our findings suggested that the risk of chromosomal abnormalities was increased when GITO was accompanied by other ultrasound anomalies; thus, chromosomal abnormalities and fetal anatomy should be carefully evaluated for pregnancy management of fetal GITO.

Garcin syndrome caused by rhino-orbito-cerebral mucormycosis

Total paralysis of all or near all unilateral cranial nerves indicates Garcin syndrome. Garcin syndrome caused by Rhino-Orbito-Cerebral Mucormycosis (ROCM) complicating with cerebral infarction has been reported rarely. ROCM is an opportunistic fungal infection with high morbidity and mortality rates despite treatment due to acute angioinvasive infections. We report the case of a 69-year-old female, with a history of type 2 Diabetes Mellitus (DM), who presented Garcin syndrome caused by ROCM.

Reducing non-surgical readmissions on a gynecologic oncology service

ObjectiveTo assess the effects of a quality improvement (QI) initiative designed to reduce non-surgical readmissions on a gynecologic oncology service. MethodsA two-phase QI initiative was implemented on an inpatient gynecologic oncology service to reduce non-surgical 30-day readmissions. Phase 1, from July 2018 to June 2020, included trainee education, frequent physical therapy consultation, pharmacy discharge medication review, 72-h post-discharge telephone call, and standardized 10-day clinic follow-up after discharge. Phase 2, from July 2020 to December 2020, incorporated a nurse practitioner to perform discharge navigation and arrange outpatient follow-up. The incidence of non-surgical readmissions during these phases was compared to that of a baseline period (July 2017–June 2018). We also assessed readmissions to identify common indications and evaluate potential demographic and clinical risk factors. ResultsOf 390 total non-surgical gynecologic oncology admissions, 100 were readmitted within 30 days (25.6%). Gastrointestinal tract (GI) obstruction, malignancy-associated pain and infection were the most common symptomatic diagnoses at the index admission, and 30% of readmitted patients had an identical indication for readmission. Compared to the baseline period, we observed a reduction in non-surgical readmissions from 34.1% to 22.6% in Phase 1 and to 18.9% in Phase 2 (p < 0.03) based on internal review, and a reduction from 13.9% to 11.9% in Phase 1 and to 4.7% in Phase 2 (p = 0.04) based on healthcare performance tracking data. Conclusions30-day hospital readmission among non-surgical gynecologic oncology patients is common. Implementation of a multifaceted readmissions reduction QI initiative significantly improved readmission rates.

A Rare Cause of Bowel Obstruction Mimicking Colon Cancer: Endometriosis

Intestinal involvement is observed in a significant portion of patients diagnosed with endometriosis. Involvement is often on the serosal surface of the sigmoid colon. Rarely, it takes place in the colonic mucosa and lymph nodes, causing lumen obstruction. Colonoscopic biopsies may be insufficient in the differential diagnosis of malignancy and diverticulitis. We report a case of a 41-year-old premenopausal female patient with endometriosis located in the ampulla recti causing complete intestinal obstruction. Although having a significant rectal mucosal mass, the diagnosis could not be made with tissue samples taken by endoscopy. During the examination, the patient developed ileus. With the preliminary diagnosis of rectal cancer, surgical intervention was applied with oncological principles, and its treatment was performed with opening a diverting ileostomy. Diagnosis of rectosigmoid endometriosis is difficult. In women of childbearing age, rectosigmoid endometriosis should be kept in mind in lower gastrointestinal tract obstructions.

Stomach perforation as a complication of non-diagnosed pyloric atresia type I

Pyloric atresia is a rare malformation with severe complications, if the diagnosis is delayed. We report the case of a 5 day old girl who required an emergency operation because of stomach perforation due to pyloric atresia type I. The assosciation of PA with Epidermyolisis bullosa is well described and early imaging as ultrasound and x-ray to exclude pyloric atresia is recommended in children with suspect skin or hereditary predisposition. Otherwise healthy neonates with pyloric atresia run the risk that the sufficient surgical therapy is initiated when complications already appeared. We recommend immediate diagnostic steps to avoid life-threatening consequences when newborns show symptoms of upper gastrointestinal tract obstruction in the first hours of life.

Wilke's Syndrome: A Missed Diagnosis in Pulmonary Tuberculosis in an Adolescent

Background: Superior mesenteric artery (SMA) syndrome or Wilke's syndrome is a rare, atypical cause of upper gastrointestinal tract obstruction. It occurs due to acute angulation between SMA and aorta causing compression of the third part of the duodenum inbetween them leading to proximal intestinal obstruction. Clinical Description: SMA syndrome occurs mostly in patients who have significant weight loss. It occurs mostly due to the loss of the retroperitoneal fat pad, which serves as a cushion for the duodenum protecting it from compression between the two arteries. Causes include prolonged supine bed rest, spine surgery, an unusual high insertion of ligament of Treitz, other causes leading to weight loss, and congenital anatomical defects. Symptoms include weight loss, bilious vomiting, pain abdomen, postprandial nausea, early satiety, and anorexia. We report a 14-year-old female, a known case of pulmonary tuberculosis, who developed pneumothorax followed by acute gastric dilatation superadded with septicemia and upper gastrointestinal tract obstructive symptoms during the hospital course. Management: Detailed history and radio imaging such as barium studies or contrast-enhanced computerized tomography abdomen are required for diagnosis. Treatment includes conservative management such as gastric decompression, maintenance of electrolytes, nutritional rehabilitation via nasojejunal feeding, orally or parenterally. Treatment aims to restore the mesenteric fat pad to increases the angle between the two arteries. If it fails, surgery needs to be planned wherein duodenojejunostomy can be performed. Conclusion: An increased index of suspicion should be kept for this rare syndrome in children, especially in cases associated with significant weight loss. This may lead to timely diagnosis and saving a precious life.

All Tied Up: Not Your Typical Distended Abdomen

Question: A 28-year-old woman with a history of iron deficiency anemia and pos-traumatic stress disorder was evaluated in the emergency department for 2 weeks of intermittent abdominal discomfort, nausea, and vomiting. Physical examination revealed a young woman with a hard distended abdomen that was diffusely tender to palpation. Lab oratory tests were significant for a low hemoglobin (9.4 gm/dL), low mean corpuscular volume (75 fL), and low ferritin (7). Her white blood cell volume (7.9 × 10³ mL) and lactic acid (1.3 mEq/L) were normal. A pregnancy test was negative and an abdominal computed tomography scan was performed (Figure A). What is the diagnosis and what is the next best step in management? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. This patient has pica and had been consistently ingesting elastic hair ties for the past 5 years—since the birth of her child. The computed tomography scan (Figure A) shows her stomach to be markedly distended with ingested material (innumerable, thin, linear, radiodense structures) located throughout the stomach and proximal duodenum. An upper endoscopy with monitored anesthesia care was subsequently performed and confirmed the presence of ingested hair ties throughout the gastric cavity (Figure B). The ties had coalesced into several large, tangled, hardened masses consistent with gastric bezoars. An overtube was placed and the foreign bodies were removed in sequential fashion with a rat-tooth forceps and cold snare. After partial removal, a 1.4-cm nonbleeding crater ulcer was found at the incisura (Figure C) and a large number of ties were extricated from the pyloric sphincter. In total, 172 individual bands were removed (Figure D). The patient recovered without event, and hematology and psychiatry services were consulted. Pica refers to repeated consumption of nonfood substances and has been associated with both iron deficiency anemia and pregnancy, although the underlying mechanism is not well-understood.1Al Nasser Y. Muco E. Alsaad A.J. Pica.in: StatPearls. Treasure. StatPearls Publishing, Island, FL2021Google Scholar A majority of ingested objects pass without the need for intervention, although the need seems to be higher with intentional ingestions.2Ikenberry S.O. Jue T.L. Anderson M.A. et al.ASGE Standards of Practice CommitteeManagement of ingested foreign bodies and food impactions.Gastrointest Endosc. 2011; 73: 1085-1091Abstract Full Text Full Text PDF PubMed Scopus (446) Google Scholar A gastric bezoar specifically refers to a collection of indigestible material accumulating in the stomach.3Pfau P.R. Benson M. Foreign bodies, bezoars, and caustic ingestions.in: Sleisenger and Fordtran’s gastrointestinal and liver disease- 2 volume set: pathophysiology, diagnosis, management. 11th ed. Elsevier, New York2020: 399-410Google Scholar These generally occur in the setting of poor gastric emptying, with vegetable matter (phytobezoar), hair (trichobezoar), and medications (pharmacobezoars) being the most common.3Pfau P.R. Benson M. Foreign bodies, bezoars, and caustic ingestions.in: Sleisenger and Fordtran’s gastrointestinal and liver disease- 2 volume set: pathophysiology, diagnosis, management. 11th ed. Elsevier, New York2020: 399-410Google Scholar Clinical manifestations include anorexia, nausea, vomiting, and early satiety. Gastric ulceration secondary to pressure necrosis and mechanical obstruction secondary to accumulation in the small intestine can occur.3Pfau P.R. Benson M. Foreign bodies, bezoars, and caustic ingestions.in: Sleisenger and Fordtran’s gastrointestinal and liver disease- 2 volume set: pathophysiology, diagnosis, management. 11th ed. Elsevier, New York2020: 399-410Google Scholar Urgent endoscopy or surgical intervention are indicated in patients with objects causing gastrointestinal tract obstruction.2Ikenberry S.O. Jue T.L. Anderson M.A. et al.ASGE Standards of Practice CommitteeManagement of ingested foreign bodies and food impactions.Gastrointest Endosc. 2011; 73: 1085-1091Abstract Full Text Full Text PDF PubMed Scopus (446) Google Scholar An overtube facilitates the sequential removal of foreign bodies with protection of the airway. If endoscopic therapy is unsuccessful or complications such as perforation arise, surgical intervention may be required.3Pfau P.R. Benson M. Foreign bodies, bezoars, and caustic ingestions.in: Sleisenger and Fordtran’s gastrointestinal and liver disease- 2 volume set: pathophysiology, diagnosis, management. 11th ed. Elsevier, New York2020: 399-410Google Scholar

Causes of upper gastrointestinal tract obstruction

Obstruction of the upper gastrointestinal tract, caused by blocked passage in the oesophagus, stomach or duodenum, is an important clinical and diagnostic problem in gastroenterological practice. The typical symptoms are dysphagia, postprandial vomiting, epigastric pain and weight loss. Post-inflammatory oesophageal lesions associated with reflux oesophagitis are the most common cause of obstruction. Other common causes include foreign bodies, neoplasms, chemical burns of the oesophagus and radiation-induced stenosis. In more than 2/3 cases, foreign bodies are localised in the proximal part of the oesophagus, but anatomical abnormalities, such as a Schatzki ring or post-inflammatory stenosis, increase the risk of food bolus impaction in the distal part of the oesophagus. Radiotherapy of head and neck tumours may cause stenosis, which affects more than 7% of patients treated this way. For the stomach and duodenum, 50–80% of obstruction cases are associated with neoplastic processes, with gastric cancer and pancreatic adenocarcinoma accounting for 35% and 15–25% of these cases, respectively. Mild causes of peripyloric obstruction include gastric and duodenal peptic ulcer, peritoneal adhesions, gastric polyps and Crohn’s disease. Symptoms of temporary pylorus obstruction can be caused by large, gastric hyperplastic pedunculated polyps. Therapeutic endoscopy is the most commonly used method for upper gastrointestinal tract obstruction. Depending on the cause, it involves foreign body removal, balloon enteroscopy, stenting with self-expanding metallic stents, and, in the case of treatment failure, surgical resection or palliative gastrojejunostomy.

Bezoar de dinero: reporte de bezoar atípico, su manejo y una revisión de la literatura

Objetivos: presentar el manejo laparoscópico en un caso de bezoar atípico y una revisión de la literatura.&#x0D; Materiales y métodos: se presenta el caso de un paciente de sexo masculino de 67 años con síndrome pilórico debido a una obstrucción intestinal por cuerpo extraño.&#x0D; Resultados: se encuentra como hallazgo endoscópico un bezoar atípico (bezoar de dinero) impactado en la región prepilórica sin posibilidad de resolución por este medio, por lo cual se considera el manejo laparoscópico.&#x0D; Discusión: los bezoares se definen como cualquier objeto el cual tuvo una ingesta voluntaria o involuntaria, que se aloja en alguna parte del tracto gastrointestinal superior, con mayor frecuencia a nivel gástrico, y no se puede digerir por los mecanismos fisiológicos del cuerpo; además, se clasifican según su composición.&#x0D; Conclusiones: en pacientes con obstrucción intestinal alta debido a cuerpos extraños en los cuales el manejo endoscópico falla, el manejo quirúrgico mínimamente invasivo con cirugía laparoscópica es viable y eficaz.

Fecal impaction and colon obstruction

Fecal impaction is an important cause of lower gastrointestinal tract obstruction and carries high risk of mortality and morbidity, it is highly emphasized to early identify it to minimize any risk of complication. Recurrence is common, therefore preventive modalities as increasing the dietary fiber content to 30 gm/day, water intake, or discontinuation of medications that contribute to colon hypomotility. In this paper, I am pointing off the early recognition and treatment of fecal impaction to avoid lethal complications, therefore physicians should have higher level of suspicions because if fecal impaction goes unrecognized this will lead to fatal morbidity and mortality.

Magnetic resonance imaging of the fetal gastrointestinal system.

In this paper the authors review the normal imaging appearance of the fetal gastrointestinal tract and patterns of fetal gastrointestinal tract obstruction. The authors include a detailed summary from esophagus to the rectum, including the expected pattern of meconium and small-bowel contents at different gestational ages. Common fetal gastrointestinal tract obstructions are reviewed with accompanying case examples, emphasizing the role of the meconium and bowel-caliber patterns in establishing differential diagnoses. This review also includes imaging pitfalls, complications of gastrointestinal tract obstruction, and implications for patient care.